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Older Persons (older + person)
Selected AbstractsAustralian and New Zealand Society for Geriatric Medicine Position Statement No. 6 , Under-nutrition and the Older PersonAUSTRALASIAN JOURNAL ON AGEING, Issue 2 2009Article first published online: 23 JUN 200 First page of article [source] Report from BSG/BDACDS Winter meeting ,Oral Assessment and Care Planning for the Older Person'GERODONTOLOGY, Issue 1 20044th December 200, African Studies, London, School of Oriental [source] Integrating Health and Social Care Services for Older Persons: Evidence from Nine European CountriesHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2006Jon Glasby No abstract is available for this article. [source] Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older PersonsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2009Thomas E. Finucane MD No abstract is available for this article. [source] Pharmacological Management of Persistent Pain in Older PersonsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2009American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons First page of article [source] Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older PersonsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2009AGSF, Harrison G. Bloom MD Sleep-related disorders are most prevalent in the older adult population. A high prevalence of medical and psychosocial comorbidities and the frequent use of multiple medications, rather than aging per se, are major reasons for this. A major concern, often underappreciated and underaddressed by clinicians, is the strong bidirectional relationship between sleep disorders and serious medical problems in older adults. Hypertension, depression, cardiovascular disease, and cerebrovascular disease are examples of diseases that are more likely to develop in individuals with sleep disorders. Conversely, individuals with any of these diseases are at a higher risk of developing sleep disorders. The goals of this article are to help guide clinicians in their general understanding of sleep problems in older persons, examine specific sleep disorders that occur in older persons, and suggest evidence- and expert-based recommendations for the assessment and treatment of sleep disorders in older persons. No such recommendations are available to help clinicians in their daily patient care practices. The four sections in the beginning of the article are titled, Background and Significance, General Review of Sleep, Recommendations Development, and General Approach to Detecting Sleep Disorders in an Ambulatory Setting. These are followed by overviews of specific sleep disorders: Insomnia, Sleep Apnea, Restless Legs Syndrome, Circadian Rhythm Sleep Disorders, Parasomnias, Hypersomnias, and Sleep Disorders in Long-Term Care Settings. Evidence- and expert-based recommendations, developed by a group of sleep and clinical experts, are presented after each sleep disorder. [source] Functional Trajectories in Older Persons Admitted to a Nursing Home with Disability After an Acute HospitalizationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2009Thomas M. Gill MD OBJECTIVES: To characterize the functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization. DESIGN: Prospective cohort study of 754 community-living persons aged 70 and older who were initially nondisabled in four essential activities of daily living (ADLs). SETTING: Greater New Haven, Connecticut. PARTICIPANTS: The analytical sample included 296 participants who were newly admitted to a nursing home with disability after an acute hospitalization. MEASUREMENTS: Information on nursing home admissions, hospitalizations, and disability in essential ADLs was ascertained during monthly telephone interviews for up to 9 years. Disability was defined as the need for personal assistance in bathing, dressing, walking inside one's home, or transferring from a chair. RESULTS: The median time to the first nursing home admission with disability after an acute hospitalization was 46 months (interquartile range 27.5,75.5), and the mean numberąstandard deviation of ADLs that participants were disabled in upon admission was 3.0ą1.2. In the month preceding hospitalization, 189 (63.9%) participants had no disability. The most common functional trajectory was discharged home with disability (46.3%), followed by continuous disability in the nursing home (27.4%), discharged home without disability (21.6%), and noncontinuous disability in the nursing home (4.4%). Only 96 (32.4%) participants returned home at (or above) their premorbid level of function. CONCLUSION: The functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization are generally poor. Additional research is needed to identify the factors responsible for these poor outcomes. [source] Stopping to Rest During a 400-Meter Walk and Incident Mobility Disability in Older Persons with Functional LimitationsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2009Sonja Vestergaard PhD OBJECTIVES: To examine the association between stopping to rest during a 400-m usual-pace walk test (400-MWT) and incident mobility disability in older persons with functional limitations. DESIGN: Prospective cohort study. SETTING: Community based. PARTICIPANTS: Four hundred twenty-four participants in the Lifestyle Intervention and Independence for Elders Pilot (LIFE-P) Study aged 70 to 89 with functional limitations (summary score ,9 on the Short Physical Performance Battery (SPPB)) but able to complete the 400-MWT within 15 minutes. MEASUREMENTS: Rest stops during the 400-MWT were recorded. The onset of mobility disability, defined as being unable to complete the 400-MWT or taking more than 15 minutes to do so, was recorded at Months 6 and 12. RESULTS: Fifty-four (12.7%) participants rested during the 400-MWT at baseline, of whom 37.7% experienced mobility disability during follow-up, versus 8.6% of those not stopping to rest. Performing any rest stop was strongly associated with incident mobility disability at follow-up (odds ratio (OR)=5.4, 95% confidence interval (CI)=2.7,10.9) after adjustment for age, sex, and clinic site. This association was weaker, but remained statistically significant, after further adjusting for SPPB and time to complete the 400-MWT simultaneously (OR=2.6, 95% CI=1.2,5.9). CONCLUSION: Stopping to rest during the 400-MWT is strongly associated with incident mobility disability in nondisabled older persons with functional limitations. Given the prognostic value, rest stops should be recorded as part of the standard assessment protocol for the 400-MWT. [source] Maximizing Clinical Research Participation in Vulnerable Older Persons: Identification of Barriers and MotivatorsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2008Edward R. Marcantonio MD OBJECTIVES: To identify barriers and motivators to participation in long-term clinical research by high-risk elderly people and to develop procedures to maximize recruitment and retention. DESIGN: Quantitative and qualitative survey. SETTING: Academic primary care medicine and pre-anesthesia testing clinics. PARTICIPANTS: Fifty patients aged 70 and older, including 25 medical patients at high risk of hospitalization and 25 patients with planned major surgery. MEASUREMENTS: Fifteen- to 20-minute interviews involved open- and closed-ended questions guided by an in-depth script. Two planned study protocols were presented to each participant. Both involved serial neuropsychological assessments, blood testing, and magnetic resonance brain imaging (MRI); one added lumbar puncture (LP). Participants were asked whether they would be willing to participate in these protocols, rated barriers and incentives to participation, and were probed with open-ended questions. RESULTS: Of 50 participants (average age 78, 44% male, 40% nonwhite), 32 (64%) expressed willingness to participate in the LP-containing protocol, with LP cited as the strongest disincentive. Thirty-eight (76%) expressed willingness to participate in the protocol without LP, with phlebotomy and long interviews cited as the strongest disincentives. Altruism was a strong motivator for participation, whereas transportation was a major barrier. Study visits at home, flexible appointment times, assessments shorter than 75 minutes, and providing transportation and free parking were strategies developed to maximize study participation. CONCLUSION: Vulnerable elderly people expressed a high rate of willingness to participate in an 18-month prospective study. Participants identified incentives and barriers that enabled investigators to develop procedures to maximize recruitment and retention. [source] Withdrawal of Fall-Risk-Increasing Drugs in Older Persons: Effect on Tilt-Table Test OutcomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2007Nathalie Van Der Velde MD OBJECTIVES: To determine whether outcomes of tilt-table tests improved after withdrawal of fall-risk-increasing drugs (FRIDs). DESIGN: Prospective cohort study. SETTING: Geriatric outpatient clinic. PARTICIPANTS: Two hundred eleven new, consecutive outpatients, recruited from April 2003 until December 2004. MEASUREMENTS: Tilt-table testing was performed on all participants at baseline. Subsequently, FRIDs were withdrawn in all fallers in whom it was safely possible. At a mean follow-up of 6.7 months, tilt-table testing was repeated in 137 participants. Tilt-table testing addressed carotid sinus hypersensitivity (CSH), orthostatic hypotension (OH), and vasovagal collapse (VVC). Odds ratios (ORs) of tilt-table-test normalization according to withdrawal (discontinuation or dose reduction) of FRIDs were calculated using multivariate logistic regression analysis. RESULTS: After adjustment for confounders, the reduction of abnormal test outcomes (ORs) according to overall FRID withdrawal was 0.34 (95% confidence interval (CI)=0.06,1.86) for CSH, 0.35 (95% CI=0.13,0.99) for OH, and 0.27 (95% CI=0.02,3.31) for VVC. For the subgroup of cardiovascular FRIDs, the adjusted OR was 0.13 (95% CI=0.03,0.59) for CSH, 0.44 (95% CI=0.18,1.0) for OH, and 0.21 (95% CI=0.03,1.51) for VVC. CONCLUSION: OH improved significantly after withdrawal of FRIDs. Subgroup analysis of cardiovascular FRID withdrawal showed a significant reduction in OH and CSH. These results imply that FRID withdrawal can cause substantial improvement in cardiovascular homeostasis. Derangement of cardiovascular homeostasis may be an important mechanism by which FRID use results in falls. [source] Change in Motor Function and Risk of Mortality in Older PersonsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2007Aron S. Buchman MD OBJECTIVES: To assess the association between change in motor function and mortality. DESIGN: Prospective, observational cohort study. SETTING: Approximately 40 retirement communities across the Chicago metropolitan area participating in the Rush Memory and Aging Project. PARTICIPANTS: Eight hundred thirty-seven community-based older persons without dementia. MEASUREMENTS: Change in composite measures of motor performance and muscle strength. RESULTS: During a mean follow-up of 2.2 years, 81 persons died. In a proportional hazards model adjusted for age, sex, education, and body mass index, each 1-unit increase in the level of baseline motor performance was associated with an approximately 10% decrease in risk of mortality (hazard ratio (HR)=0.901, 95% confidence interval (CI)=0.863,0.941), and each unit of annual increase in motor performance was associated with an approximately 11% decrease in the risk of mortality (HR=0.887, 95% CI=0.835,0.942). In a similar model, each 1-unit increase in the level of baseline strength was associated with an approximately 9% decrease in the risk of mortality (HR=0.906, 95% CI=0.859,0.957), and each 1-unit annual increase in strength was associated with an approximately 10% decrease in the risk of mortality (HR=0.898, 95% CI=0.809,0.996). These results were similar when men and women were analyzed separately and after controlling for physical activity, cognition, and chronic disorders. When motor performance and muscle strength were examined in a single model, only baseline and annual change in motor performance were associated with mortality. CONCLUSION: Level and rate of change in strength and motor performance are associated with mortality. The attenuation of the association between strength and mortality by motor performance suggests that motor function is not a unitary process and that its components may vary in their associations with adverse health consequences in older persons. [source] Multimorbidity and Survival in Older Persons with Colorectal CancerJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006Cary P. Gross MD OBJECTIVES: To ascertain the effect of common chronic conditions on mortality in older persons with colorectal cancer. DESIGN: Retrospective cohort study. SETTING: Population-based cancer registry. PARTICIPANTS: Patients in the Surveillance Epidemiology and End Results,Medicare linked database who were aged 67 and older and had a primary diagnosis of Stage 1 to 3 colorectal cancer during 1993 through 1999. MEASUREMENTS: Chronic conditions were identified using claims data, and vital status was determined from the Medicare enrollment files. After estimating the adjusted hazard ratios for mortality associated with each condition using a Cox model, the population attributable risk (PAR) was calculated for the full sample and by age subgroup. RESULTS: The study sample consisted of 29,733 patients, 88% of whom were white and 55% were female. Approximately 9% of deaths were attributable to congestive heart failure (CHF; PAR =9.4%, 95% confidence interval (CI) =8.4,10.5%), more than 5% were attributable to chronic obstructive pulmonary disease (COPD; PAR =5.3%, 95% CI=4.7,6.6%), and nearly 4% were attributable to diabetes mellitus (PAR =3.9%, 95% CI=3.1,4.8%). The PAR associated with CHF increased with age, from 6.3% (95% CI=4.4,8.8%) in patients aged 67 to 70 to 14.5% (95% CI=12.0,17.5%) in patients aged 81 to 85. Multiple conditions were common. More than half of the patients who had CHF also had diabetes mellitus or COPD. The PAR associated with CHF alone (4.29%, 95% CI=3.68,4.94%) was similar to the PAR for CHF in combination with diabetes mellitus (3.08, 95% CI=2.60,3.61%) or COPD (3.93, 95% CI=3.41,4.54%). CONCLUSION: A substantial proportion of deaths in older persons with colorectal cancer can be attributed to CHF, diabetes mellitus, and COPD. Multimorbidity is common and exerts a substantial effect on colorectal cancer survival. [source] Bathing Disability in Community-Living Older Persons: Common, Consequential, and ComplexJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2004Aanand D. Naik MD Objectives: To identify the specific bathing subtasks that are affected in community-living-older persons with bathing disability and to determine the self-reported reasons for bathing disability. Design: Cross-sectional study. Setting: General community of greater New Haven, Connecticut. Participants: A total of 626 community-living persons, aged 73 and older, who completed a comprehensive assessment, including a detailed evaluation of bathing disability. Measurements: Trained research nurses assessed bathing disability (defined as requiring personal assistance or having difficulty washing and drying the whole body), the specific bathing subtasks that were affected, and the main reasons (up to three) for bathing disability. Results: Disability in bathing was present in 195 (31%) participants; of these, 97 required personal assistance (i.e., dependence), and 98 had difficulty bathing. Participants with bathing disability reported a meanąstandard deviation of 4.0ą2.4 affected subtasks. The prevalence rate of disability for the eight prespecified bathing subtasks ranged from 25% for taking off clothes to 75% for leaving the bathing position. The majority of participants (59%) provided more than one reason for bathing disability. The most common reasons cited by participants for their bathing disability were balance problems (28%), arthritic complaints (26%), and fall or fear of falling (23%). Conclusion: For community-living older persons, disability in bathing is common, involves multiple subtasks, and is attributable to an array of physical and psychological problems. Preventive and restorative interventions for bathing disability will need to account for the inherent complexity of this essential activity of daily living. [source] Selected As the Best Paper in the 1990s: Reducing Frailty and Falls in Older Persons: An Investigation of Tai Chi and Computerized Balance TrainingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2003FAPTA, Steven L. Wolf PhD Objectives: To evaluate the effects of two exercise approaches, tai chi (TC) and computerized balance training (BT), on specified primary outcomes (biomedical, functional, and psychosocial indicators of frailty) and secondary outcomes (occurrences of fall). Design: The Atlanta Frailty and Injuries: Cooperative Studies and Intervention Techniques, a prospective, randomized, controlled clinical trial with three arms (TC, BT, and education (ED)). Intervention length was 15 weeks, with primary outcomes measured before and after intervention and at 4-month follow-up. Falls were monitored continuously throughout the study. Setting: Persons aged 70 and older living in the community. Participants: A total of 200 participants, 162 women and 38 men; mean age was 76.2. Measurements: Biomedical (strength, flexibility, cardiovascular endurance, body composition), functional instrumental activities of daily living (IADL), and psychosocial well-being (Center for Epidemiological Studies for Depression scale, fear of falling questionnaire, self-perception of present and future health, mastery index, perceived quality of sleep, and intrusiveness) variables. Results: Grip strength declined in all groups, and lower extremity range of motion showed limited but statistically significant changes. Lowered blood pressure before and after a 12-minute walk was seen following TC participation. Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group (P=.046 and P=.058, respectively). After adjusting for fall risk factors, TC was found to reduce the risk of multiple falls by 47.5%. Conclusion: A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty. This intervention can also have favorable effects upon the occurrence of falls. TC warrants further study as an exercise treatment to improve the health of older people. [source] Income-Related Differences in the Use of Evidence-Based Therapies in Older Persons with Diabetes Mellitus in For-Profit Managed CareJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2003Arleen F. Brown MD OBJECTIVES: To determine whether income influences evidence-based medication use by older persons with diabetes mellitus in managed care who have the same prescription drug benefit. DESIGN: Observational cohort design with telephone interviews and clinical examinations. SETTING: Managed care provider groups that contract with one large network-model health plan in Los Angeles County. PARTICIPANTS: A random sample of community-dwelling Medicare beneficiaries with diabetes mellitus aged 65 and older covered by the same pharmacy benefit. MEASUREMENTS: Patients reported their sociodemographic and clinical characteristics. Annual household income (,$20,000 or <$20,000) was the primary predictor. The outcome variable was use of evidence-based therapies determined by a review of all current medications brought to the clinical examination. The medications studied included use of any cholesterol-lowering medications, use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) for cholesterol lowering, aspirin for primary and secondary prevention of cardiovascular disease, and angiotensin-converting enzyme (ACE) inhibitors in those with diabetic nephropathy. The influence of income on evidence-based medication use was adjusted for other patient characteristics. RESULTS: The cohort consisted of 301 persons with diabetes mellitus, of whom 53% had annual household income under $20,000. In unadjusted analyses, there were lower rates of use of all evidence-based therapies and lower rates of statin use for persons with annual income under $20,000 than for higher-income persons. In multivariate models, statin use was observed in 57% of higher-income versus 30% of lower-income respondents with a history of hyperlipidemia (P = .01) and 66% of higher-income versus 29% of lower-income respondents with a history of myocardial infarction (P = .03). There were no differences by income in the rates of aspirin or ACE inhibitor use. CONCLUSION: Among these Medicare managed care beneficiaries with diabetes mellitus, all of whom had the same pharmacy benefit, there were low rates of use of evidence-based therapies overall and substantially lower use of statins by poorer persons. [source] Older Persons in the Emergency Medical Care SystemJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2002Jane McCusker No abstract is available for this article. [source] Healthcare for Older Persons, A Country Profile: NigeriaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2002Bola O. Akanji PhD The Nigerian population is undergoing demographic transition, with an increasing population of older people. Nuclear and extended family members traditionally care for older persons at home. We have observed changes in home living conditions due to reduced family size, and urban migration for economic reasons are likely to affect the care of older people. The inadequately funded healthcare system has placed little emphasis on the care of older people because there are more-pressing health problems and funding for older people is limited. This paper advocates improved attention to the health needs of older people through improved budgetary allocation, revision of the training curriculum of all cadres of health staff to include geriatrics, and utilization of primary healthcare facilities. [source] Predicting Cognitive Impairment in High-Functioning Community-Dwelling Older Persons: MacArthur Studies of Successful AgingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2002Joshua Chodosh MD, MSHS OBJECTIVES: To examine whether simple cognitive tests, when applied to cognitively intact older persons, are useful predictors of cognitive impairment 7 years later. DESIGN: Cohort study. SETTING: Durham, North Carolina; East Boston, Massachusetts; and New Haven, Connecticut, areas that are part of the National Institute on Aging Established Populations for Epidemiological Studies of the Elderly. PARTICIPANTS: Participants, aged 70 to 79, from three community-based studies, who were in the top third of this age group, based on physical and cognitive functional status. MEASUREMENTS: New onset of cognitive impairment as defined by a score of less than 7 on the Short Portable Mental Status Questionnaire (SPMSQ) in 1995. RESULTS: At 7 years, 21.8% (149 of 684 subjects) scored lower than 7 on the SPMSQ. Using multivariate logistic regression, three baseline (1988) cognitive tests predicted impairment in 1995. These included two simple tests of delayed recall,the ability to remember up to six items from a short story and up to 18 words from recall of Boston Naming Test items. For each story item missed, the adjusted odds ratio (AOR) for cognitive impairment was 1.44 (95% confidence interval (CI) = 1.16,1.78, P < .001). For each missed item from the word list, the AOR was 1.20 (95% CI = 1.09,1.31, P < .001). The Delayed Recognition Span, which assesses nonverbal memory, also predicted cognitive impairment, albeit less strongly (odds ratio = 1.06 per each missed answer, 95% CI = 1.003,1.13, P = .04). CONCLUSIONS: This study identifies measures of delayed recall and recognition as significant early predictors of subsequent cognitive decline in high-functioning older persons. Future efforts to identify those at greatest risk of cognitive impairment may benefit by including these measures. [source] The Management of Persistent Pain in Older PersonsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue S6 2002AGS Panel on Persistent Pain in Older Persons First page of article [source] The Value of Serum Albumin and High-Density Lipoprotein Cholesterol in Defining Mortality Risk in Older Persons with Low Serum CholesterolJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2001Stefano Volpato MD OBJECTIVES: To investigate the relationship between low cholesterol and mortality in older persons to identify, using information collected at a single point in time, subgroups of persons with low and high mortality risk. DESIGN: Prospective cohort study with a median follow-up period of 4.9 years. SETTINGS: East Boston, Massachusetts; New Haven, Connecticut; and Iowa and Washington counties, Iowa. PARTICIPANTS: Four thousand one hundred twenty-eight participants (64% women) age 70 and older at baseline (mean 78.7 years, range 70,103); 393 (9.5%) had low cholesterol, defined as ,160 mg/dl. MEASUREMENTS: All-cause mortality and mortality not related to coronary heart disease and ischemic stroke. RESULTS: During the follow-up period there were 1,117 deaths. After adjustment for age and gender, persons with low cholesterol had significantly higher mortality than those with normal and high cholesterol. Among subjects with low cholesterol, those with albumin> 38 g/L had a significant risk reduction compared with those with albumin ,38 g/L (relative risk (RR) = 0.57; 95% confidence interval (CI) = 0.41,0.79). Within the higher albumin group, high-density lipoprotein cholesterol (HDL-C) level further identified two subgroups of subjects with different risks; participants with HDL-C <47 mg/dl had a 32% risk reduction (RR = 0.68; 95% CI = 0.47,0.99) and those with HDL-C ,47 mg/dl had a 62% risk reduction (RR = 0.38; 95% CI = 0.20,0.68), compared with the reference category; those with albumin ,38 g/L and HDL-C <47 mg/dl. CONCLUSIONS: Older persons with low cholesterol constitute a heterogeneous group with regard to health characteristics and mortality risk. Serum albumin and HDL-C can be routinely used in older patients with low cholesterol to distinguish three subgroups with different prognoses: (1) high risk (low albumin), (2) intermediate risk (high albumin and low HDL-C), and (3) low risk (high albumin and high HDL-C). [source] Ideology, Context, and Obligations to Assist Older PersonsJOURNAL OF MARRIAGE AND FAMILY, Issue 4 2002Timothy Killian Are older adults responsible for meeting their own needs, is it their children's obligation to care for them, or is there a collective responsibility to see that older adults have their needs met? The purpose of this study was to examine the normative obligations of individuals, family members, and the government to provide for the needs of older adults. The authors examined how ideological beliefs and contextual circumstances are related to beliefs about obligations to older persons. Data were collected from phone interviews of a sample of 270 adults who were over 40 years old. The results indicate that ideological beliefs were better predictors of normative obligations than were contextual variables. Future research should reflect the complex relationships among ideological beliefs, contextual circumstances, and normative obligation beliefs. [source] Conclusions and Recommendations for Policies on Rural Aging in the First Decades of the 21st CenturyTHE JOURNAL OF RURAL HEALTH, Issue 4 2001Hana M. Hermanova M.D., Ph.D. ABSTRACT: The 2000 Forum on Rural Aging: Policy Debates was one of the main tracks of the first International Conference on Rural Aging held in Charleston, W.Va., in June 2000. The 2000 Forum was a follow-up to the Expert Group Meeting on Rural Aging, which met at Shepherdstown, W.Va., in May 1999. That group considered policy implications of the 1999 International Year of Older Persons for rural aging in four key areas: the situation of older people, multigenerational relationships, lifelong development, and the development and aging of rural populations. As a direct follow-up of the Shepherdstown Expert Group Meeting, the 2000 Forum on Rural Aging formulated the Conclusions and Recommendations for Policies on Rural Aging through a series of working groups. The Conclusions and Recommendations were endorsed by the Conference Plenary Session on June 11, 2000. The Draft Recommendations for Policies on Rural Aging were available for comments on the Internet in the remaining part of the year 2000. Many comments were received. Hana Hermanova and Sally Richardson incorporated the comments into the finalized version. [source] Prevalence and characteristics of older community residents with mild cognitive declineGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2002Yoshinori Fujiwara Background:, Cognitive impairment is a major health issue, but epidemiological data on mild cognitive decline have been almost absent in Japan. Methods: Of all residents aged 65 years and over living in Yoita town, Niigata Prefecture, Japan in the year 2000 (n = 1673), 1544 participated in the interview survey held at community halls or at home (92.3% response). They underwent the Mini-Mental State Examination (MMSE) for assessment of cognitive function and answered questionnaires comprising socio-demographic, psychological, physical and medical, and social activity items. Higher-level functional capacities were evaluated with the Tokyo Metropolitan Index of Competence (TMIG-Index of Competence). According to subject's age and MMSE score, all subjects were classified into 3 groups: control (MMSE,>,1 SD below age-specific means), mild cognitive decline (MMSE,,,21 and ,,1 SD below age-specific means), and severe cognitive decline (MMSE,,,20), and compared various characteristics among these groups. Results: Mean MMSE score of the subjects showed a linear decline with advancing age. Among the participants, 232 (15.2%) were classified as mild cognitive decline. Compared with the controls, the subjects with mild cognitive decline reported poorer subjective health, more depressive moods, more history of stroke, more prevalence of basic activity of daily living (BADL) disability, and lower higher-level functional capacity, even after controlling for possible confounding factors. They also reported a low level of social activities: both participating in group activities and enjoying hobbies were less frequent. Their food intake pattern tended to be monotonous. Conclusions: Older persons with mild cognitive decline comprised a substantial proportion (15.2%) of the community-dwelling older population. In addition to lower cognitive function, they had lower levels of functional capacity and social activity. [source] Socio-demographic factors related to functional limitations and care dependency among older EgyptiansJOURNAL OF ADVANCED NURSING, Issue 5 2010Thomas Boggatz boggatz t., farid t., mohammedin a., dijkstra a., lohrmann c. & dassen t. (2010) Socio-demographic factors related to functional limitations and care dependency among older Egyptians. Journal of Advanced Nursing,66(5), 1047,1058. Abstract Title.,Socio-demographic factors related to functional limitations and care dependency among older Egyptians. Aim., This paper is a report of a study determining the relationship of socio-demographic factors to functional limitations and care dependency among older care recipients and non-care recipients in Egypt. Background., The population is ageing in Egypt and age-related functional limitations are increasing. Age and gender influence this phenomenon, but its relationship to socio-economic status has not yet been demonstrated for Egypt. Functional limitations are an antecedent to care dependency, which also may be associated with these socio-demographic factors. Method., A cross-sectional study with a two-group comparative design was conducted in Greater Cairo. The sample was composed of 267 non-care recipients and 344 care recipients. Path analysis was used to determine the relationship between variables. Age, gender and acceptance of care were covariates in the multiple regressions. Analyses were conducted separately for care recipients and non-care recipients. Results., Among non-care recipients, lower socio-economic status was related to more functional limitations and higher care dependency. This relationship was not found among care recipients. Conclusion., Older persons from low income groups are more likely to become care dependent but are less able to pay for required care. Currently, untrained volunteer groups of religious organizations try to support these older people in the poorer strata of Egyptian society. Training in the basics of care might help to make their work more effective. [source] Overweight and Obesity in Old Age Are Not Associated with Greater Dementia RiskJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2008(See editorial comments by Dr. David S. Knodman, 2350), pp 234 OBJECTIVES: To describe the association between body mass index (BMI) and dementia risk in older persons. DESIGN: Prospective population-based study, with 8 years of follow-up. SETTING: The municipality of Lieto, Finland, 1990/91 and 1998/99. PARTICIPANTS: Six hundred five men and women without dementia aged 65 to 92 at baseline (mean age 70.8). MEASUREMENTS: Weight and height were measured at baseline and at the 8-year follow-up. Dementia was clinically assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. RESULTS: Eighty-six persons were diagnosed with dementia. Cox regression analyses, adjusted for age, sex, education, cardiovascular diseases, smoking, and alcohol use, indicated that, for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio (HR)=0.92, 95% confidence interval (CI)=0.87,0.97). This association remained significant when individuals who developed dementia early during the first 4 years of follow-up were excluded from the analyses (HR=0.93, 95% CI=0.86,0.99). Women with high BMI scores had a lower dementia risk (HR=0.90, 95% CI=0.84,0.96). Men with high BMI scores also tended to have a lower dementia risk, although the association did not reach significance (HR=0.95, 95% CI=0.84,1.07). CONCLUSION: Older persons with higher BMI scores have less dementia risk than their counterparts with lower BMI scores. High BMI scores in late life should not necessarily be considered to be a risk factor for dementia. [source] Incidence of Loss of Ability to Walk 400 Meters in a Functionally Limited Older PopulationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2004Milan Chang PhD Objectives: To assess the incidence of and factors related to nondisabled but functionally limited older adults aged 75 to 85 years losing the ability to walk 400 m. Design: Observational study with average follow-up of 21 months. Setting: Community. Participants: At baseline, 101 persons with objective signs of functional limitations and intact cognitive function agreed to participate in the study. Of these, 81 were able to walk 400 m at baseline, and 62 participated in the follow-up examination. Measurements: Mobility disability was defined as an inability to complete a 400-m walk test. At baseline, eligible participants (n=81) had the ability to walk 400 m, scored between 4 and 9 on the Short Physical Performance Battery (SPPB; range 0,12), and scored 18 or more on the Mini-Mental State Examination. Demographics, difficulty in daily activities, disease status, behavioral risk factors, and muscle strength were assessed at baseline and follow-up. Results: Of 62 persons at follow-up, 21 (33.9%) developed incident mobility disability. The strongest predictors of loss of mobility were the time to complete the 400-m walk at baseline (odds ratio (OR)=1.6 per 1-minute difference, 95% confidence interval (CI)=1.04,2.45), and decline in SPPB score over the follow-up (OR=1.4 per 1-point difference, 95% CI=1.01,1.92). Conclusion: Older persons with functional limitations have a high rate of loss of ability to walk 400 m. The 400-m walk test is a highly relevant, discrete outcome that is an ideal target for testing preventive interventions in vulnerable older populations. [source] The Value of Serum Albumin and High-Density Lipoprotein Cholesterol in Defining Mortality Risk in Older Persons with Low Serum CholesterolJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2001Stefano Volpato MD OBJECTIVES: To investigate the relationship between low cholesterol and mortality in older persons to identify, using information collected at a single point in time, subgroups of persons with low and high mortality risk. DESIGN: Prospective cohort study with a median follow-up period of 4.9 years. SETTINGS: East Boston, Massachusetts; New Haven, Connecticut; and Iowa and Washington counties, Iowa. PARTICIPANTS: Four thousand one hundred twenty-eight participants (64% women) age 70 and older at baseline (mean 78.7 years, range 70,103); 393 (9.5%) had low cholesterol, defined as ,160 mg/dl. MEASUREMENTS: All-cause mortality and mortality not related to coronary heart disease and ischemic stroke. RESULTS: During the follow-up period there were 1,117 deaths. After adjustment for age and gender, persons with low cholesterol had significantly higher mortality than those with normal and high cholesterol. Among subjects with low cholesterol, those with albumin> 38 g/L had a significant risk reduction compared with those with albumin ,38 g/L (relative risk (RR) = 0.57; 95% confidence interval (CI) = 0.41,0.79). Within the higher albumin group, high-density lipoprotein cholesterol (HDL-C) level further identified two subgroups of subjects with different risks; participants with HDL-C <47 mg/dl had a 32% risk reduction (RR = 0.68; 95% CI = 0.47,0.99) and those with HDL-C ,47 mg/dl had a 62% risk reduction (RR = 0.38; 95% CI = 0.20,0.68), compared with the reference category; those with albumin ,38 g/L and HDL-C <47 mg/dl. CONCLUSIONS: Older persons with low cholesterol constitute a heterogeneous group with regard to health characteristics and mortality risk. Serum albumin and HDL-C can be routinely used in older patients with low cholesterol to distinguish three subgroups with different prognoses: (1) high risk (low albumin), (2) intermediate risk (high albumin and low HDL-C), and (3) low risk (high albumin and high HDL-C). [source] Impaired vision and other factors associated with driving cessation in the elderly: the Blue Mountains Eye StudyCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2001Jagjit Singh Gilhotra MBBS ABSTRACT The aim of present study was to review vision and other factors associated with the cessation of driving. As part of the Blue Mountains Eye Study, detailed demographic information, driving status and medical history were taken. Visual acuity was measured during a standardized refraction and visual fields documented. Potential risk factors were decided a priori. Among the 3654 Eye Study participants, 2831 (77.5%) had driven a motor vehicle in the past, of whom 2379 (84.0%) were current drivers and 452 (16.0%, 95% CI 14.6,17.4%) said they had stopped driving. Older persons and women were more likely to have stopped driving. After adjusting for age and sex, sensory impairment affecting vision and hearing, plus chronic medical conditions and benzodiazepine use were significantly associated with cessation of driving. The study found that sensory impairment, particularly visual parameters, was associated with the decision to stop driving by older subjects. [source] Automobile Reliance Among the Elderly: Race and Spatial Context EffectsGROWTH AND CHANGE, Issue 2 2003Brigitte Waldorf To meet their mobility needs, the elderly assign pivotal importance to the automobile despite the potential challenge of driving cessation and searching for alternatives to automobile transportation. Older persons' generally strong reliance on the automobile varies, however, by land use patterns (density) as well as by demographic and socioeconomic characteristics. This paper analyzes the effects of spatial context and personal attributes on automobile reliance among the elderly. Using the 1995 Nationwide Personal Transportation Survey (NPTS) trip data, two models of automobile reliance among elderly (65+) trip makers are estimated. The results show that spatial context effects of automobile reliance vary by demographic characteristics; in particular, they are more pronounced for black than for white elderly. Moreover, race variation in automobile reliance is strongest in urban locations rather than less dense spatial contexts. Finally, the differentiation between being a passenger rather than a driver is salient in order to understand locational and racial variations in automobile reliance among the elderly. [source] Older patients and delayed discharge from hospitalHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2000Christina R. Victor BA M Phil PhD Hon MFPHM Abstract Older people (those aged 65 years and over) are the major users of health care services, especially acute hospital beds. Since the creation of the NHS there has been concern that older people inappropriately occupy acute hospital beds when their needs would be best served by other forms of care. Many factors have been associated with delayed discharge (age, sex, multiple pathology, dependency and administrative inefficiencies). However, many of these factors are interrelated (or confounded) and few studies have taken this into account. Using data from a large study of assessment of older patients upon discharge from hospital in England, this paper examines the extent of delayed discharge, and analyses the factors associated with such delays using a conceptual model of individual and organisational factors. Specifically, this paper evaluates the relative contribution of the following factors to the delayed discharge of older people from hospital: predisposing factors (such as age), enabling factors (availability of a family carer), vulnerability factors (dependency and multiple pathology), and organisational/administrative factors (referral for services, type of team undertaking assessments). The study was a retrospective patient case note review in three hospitals in England and included four hundred and fifty-six patients aged 75 years and over admitted from their own homes, and discharged from specialist elderly care wards. Of the 456 patients in the sample, 27% had a recorded delay in their discharge from hospital of three plus days. Multivariate statistical analysis revealed that three factors independently predicted delay in discharge: absence of a family carer, entry to a nursing/residential home, and discharge assessment team staffing. Delayed discharge was not related to the hypothesised vulnerability factors (multiple dependency and multiple pathology) nor to predisposing factors (such as age or whether the older person lived alone). The delayed discharge of older people from hospital is a topic of considerable policy relevance. Our study indicated that delay was independently related to two organisational issues. First, entry into long-term care entailed lengthy assessment procedures, uncertainty over who pays for this care, and waiting lists. Second, the nature of the team assessing people for discharge was associated with delay (the nurse-coordinated team made the fewest referrals for multidisciplinary assessments and had the longest delays). Additionally, the absence of a family carer was implicated in delay, which underlines the importance of family and friends in providing posthospital care and in maintaining older people in the community. Our study suggests that considerable delay in discharging older people from hospital originates from administrative/organisational issues; these were compounded by social services resource constraints. There is still much to be done therefore to improve coordination of care in order to provide a truly ,seamless service'. [source] | |||||||||||||||||||||||||||||||||||||